Hickory Vlg Nrsg & Rhb

Location & what’s nearby

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Nearest of each type, straight-line distance. Hospitals come from the CMS Hospital General Information registry; everything else from Overture Maps (public data). Hospital and park hours are typical — call ahead to confirm.

Quality measures — how residents actually fare

Quality-measure stars summarize outcomes CMS tracks from the assessments each home submits — avoidable hospitalizations and ER visits, falls with injury, pressure ulcers, unplanned weight loss, and long-term antipsychotic use. Because the underlying data is self-reported, weigh a high score against the independent inspection record. Long-stay = permanent residents; short-stay = rehab and post-hospital stays.

Short-stay rehab — if you are coming here from a hospital

Arriving from a hospital right now? Read the discharge guide → — your appeal rights, how to slow a rushed discharge, and what to ask about the numbers below.

Therapy staffing: this home’s payroll records show 0.11 therapist hours per resident per day in 2026Q1 — more than 7% of the 13,892 homes that report any therapy hours at all.

Weekend therapy: weekend therapy hours are 26% of this home’s weekday level — it runs some therapy at the weekend, at a lower level than on weekdays. The median home that reports therapy runs 13% — weekday-focused therapy is the industry norm, not a shortfall. But recovery does not pause on a Saturday: ask what the weekend actually looks like here.

This section is about rehab stays, not living here. Most of this page — the stars, the quality measures, the inspection record — describes the home the way a permanent resident experiences it. These figures describe the short Medicare stay after a hospital discharge: a hip, a stroke, a bad infection, six weeks and home. They are different residents, different staff, often a different wing. Therapy hours are per resident in the building, not per rehab patient — the count includes every long-stay resident, and they mostly get no therapy at all. So a home with a small rehab wing inside a large nursing population reads low here even if its rehab patients get plenty of therapy, and a mostly-rehab home reads high. Use it to compare homes doing similar work, ask what a rehab resident actually gets in a day, and remember that CMS does not publish therapy minutes per patient — nobody does.

Staffing

How full it usually is: this home is certified for 74 beds and averages 66.4 residents a day — about 90% occupied, or roughly 8 beds typically open. It runs fairly full. This is a CMS average, not live availability — no public source publishes real-time vacancies, and a home can be full the day you call. Confirm with the home, and if you need a Medicaid bed specifically, ask about that separately: a home with open beds may still not have an open Medicaid bed.

Against a benchmark — not a legal minimum. In May 2024 CMS finalized the first federal staffing floor for nursing homes: 3.48 total nurse hours per resident per day, including 0.55 RN hours and 2.45 nurse-aide hours. Its hour requirements never took effect and are no longer on the books. Homes had until 2026 (2027 if rural) to comply, and that deadline never arrived: a federal court vacated the hour requirements in April 2025 (CMS has appealed), Congress then barred enforcement until 2034, and CMS formally repealed them by rule effective February 2026. This home is not required to meet these numbers, and is not violating anything by missing them. We still show the comparison because the figures are CMS’s own published estimate of adequate staffing, which makes them a useful yardstick — but they are our benchmark, not federal law: this home’s total nurse staffing of 2.67 hrs/resident/day is below the 3.48-hour benchmark and RN staffing of 0.67 is at or above the 0.55-hour RN benchmark and nurse-aide staffing of 1.43 is below the 2.45-hour aide benchmark. What federal law does require today is unchanged: “sufficient” nursing staff for residents’ needs and an RN on duty at least 8 consecutive hours a day, 7 days a week (42 CFR 483.35). Those are judged by inspectors on site, not by these averages, so read this comparison alongside the inspection record rather than as a pass/fail.

Weekend coverage: total nurse staffing is 2.05 hrs/resident/day on weekends vs 2.92 on weekdays — 30% thinner on weekends — a notable drop. RN hours go from 0.81 to 0.34 per resident-day. (Payroll-based daily records; the national median home is 15% thinner on weekends.)

This home’s total nursing-staff turnover of 28% is below the national median of 45%.

Payroll-based (PBJ) staffing hours, as reported for Jan–Mar 2026 (CMS PBJ CY2026Q1) — the most recent quarter CMS has published, so they can lag a change of operator or staffing agency. Higher is generally better. Registered-nurse coverage and weekend staffing are the numbers families most often overlook — an RN on site matters most when something goes wrong, and coverage usually thins on weekends. High turnover means residents rarely see the same caregiver twice. One caveat: these are hours as reported, not adjusted for how sick or heavy-care this home’s residents are. CMS separately publishes a case-mix-adjusted view; we show the reported hours. A home caring for higher-acuity residents needs more hours to deliver the same care, so compare these figures against homes doing similar work, and read them next to the inspection record rather than alone.

Inspection trend

Deficiencies are fewer than at the previous inspection — improving. Fewer citations over time suggests a home is fixing problems; a rising count is a warning sign — though two surveys are a short record, and survey teams differ. These counts are from the standard annual health survey only; the full citation list below may also include findings from complaint investigations, so the two won’t always add up.

Inspection deficiencies

State health-inspection citations, most serious first. Each carries an F-code (the federal rule it cites, e.g. F-684 = quality of care) and a letter A–L marking how serious and how widespread the problem was — we translate that grid into the plain tiers shown here. Wording is the official federal description.

Each letter is a CMS scope-severity level; highlighted ones are where this home has citations. A–C = no harm found; D–F = potential for harm; G–I = actual harm; J–L = immediate jeopardy. Within each band the later letter is the more widespread finding (an isolated G is one resident; a widespread I is a pattern), so rightward and downward is worse.

23 citations, most serious first. The 14 most serious are shown; the remaining 9 are one tap away and print in full.

• Immediate jeopardy · Jcited before2025-02-07 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interviews and record reviews, the facility failed to effectively supervise a resident with history of alcohol abuse. This deficient practice affected one resident (R1) out of three reviewed for supervision of an avoidable incident. R1 was able to go out into the community independently, while on a restricted community pass, somehow obtain two 1.0-liter bottles of mouthwash with alcohol, and being hospitalized later with an alcohol level of 183 (normal range is 0-10) and subsequently expiring the follow day. The Death Certificate documents the cause of death cardiopulmonary arrest due to acute kidney failure and alcohol abuse. The Immediate Jeopardy began on 1/12/25 when R1 was found yelling and screaming and with altered mental status. V1 (Administrator) and V2 DON (Director of Nursing) were notified of the immediate jeopardy on 02/04/2025 at 10:45AM. The surveyor confirmed by onsite observations, interviews, and record reviews that the immediacy was removed on 2/4/2025 but remains at level two because additional time is needed to evaluate the implementation and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Jcited before2024-01-25 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow their abuse policy by not protecting /preventing a vulnerable resident from being sexually assaulted by another resident. This affected two of four residents (R1, R2) reviewed for sexual abuse. This failure resulted in R2 entering R1's room approximately 3 hours after being admitted to the facility and sexually assaulting R1 after R1 said no to sex. The Immediate Jeopardy began on 1/8/24 when R2 entered R1's room and sexually assaulted R1. V1 (Administrator) was notified on 1/18/24 at 2PM of the Immediate Jeopardy. The surveyor confirmed by observation, interview and record review the Immediate Jeopardy was removed on 1/18/24, but noncompliance remains at Level 2 because additional time is needed to evaluate the implementation and effectiveness of the in-service training. Findings Include: R1 is a [AGE] year old with the following diagnosis: bipolar disorder, depression, and seizures. R2 is a [AGE] year old with the following diagnosis: bipolar…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Immediate jeopardy · Jcited before2023-11-02 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interviews and record reviews the facility failed to prevent an incident of staff to resident inappropriate sexual behavior, failed to prevent an incident of resident to resident sexual assault, and failed to prevent an incident of staff to resident verbal abuse. This affected four of four residents (R1, R9, R10 and R5) reviewed for sexual and verbal abuse. This failure resulted in V4 taking advantage of R1 with a diagnosis of major depression and traumatic brain injury by engaging in sexual intercourse with R1. This failure also resulted in R10 being touched and kissed inappropriately by R9. This was identified as an Immediate Jeopardy which began on 9/06/2023 when R1 was observed having sexual intercourse with V4. V3 (Administrator) was informed of the Immediate Jeopardy and the Immediate Jeopardy template was presented on 10/24//2023 at 10:25 am. The facility provided an acceptable removal plan on 10/26/23; the deficiency remains at the second level. On 10/27/23 the surveyor was onsite to confirm the removal plan was implemented. Findings include: 1. R1 face sheet…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Actual harm · Gcited before2025-01-14 · tag F0689 — failed to keep residents free of avoidable accidents; supervise adequately — isolated
  Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to supervise one resident who was identified as a high fall risk as well as dependent on staff for bed mobility and toileting, by leaving the resident on their side unattended on an elevated bed (approximately 3 feet). This affected one of three (R1) residents reviewed for falls. This failure resulted in R1 having an unwitnessed fall, being transferred to the hospital, and sustaining a pelvis fracture. Findings include: R1 was admitted to the facility on [DATE] with a diagnosis of rheumatoid arthritis, depressive disorder, bilateral osteoarthritis of knees, restless leg syndrome, and fibromyalgia. R1's Brief Interview for Mental Status score dated 11/20/24 documents a score of 14/15 which indicates cognitively intact. R1's restorative program observation dated 11/20/24: toileting hygiene documents dependent on staff. Dependent helper does all the effort. Resident does none of the effort to complete the activity. Or the assistance of two or more helpers is…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Fcited before2025-06-17 · tag F0921 — failed to keep a safe, functional, sanitary building — widespread
  Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure a clean, sanitary environment in the facility's common areas. These failures affect all 69 residents that reside within the facility. Findings include: Resident Roster (6/16/25) documents in part that 69 residents reside within the facility. R2's Minimum Data Set (MDS) dated [DATE], documents in part a brief interview of mental status (BIMS) summary score of 13, indicating R2 is cognitively intact. On 6/16/25 at 9:31 AM, R2 stated that the facility is never cleaned or repaired, just look around this place. It makes me feel bad, like I am in a prison. You can tell they don't care about me or the other people. On 6/16/25 at 10:09 AM, a facility tour was conducted with V1 (Administrator) and the following observations were affirmed with V1: dirt-stained floors within dining room, dirt stained floors within the hallways, dried brown substances dripping on the walls underneath the bulletin board in main hallway, dried yellow stain from…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Environmental Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-03-21 · tag F0568 — isolated
  Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
  What the surveyor found here — an excerpt from the official record, may be distressing

  Based on interview and record review the facility failed to follow their policy and maintain an accurate account of the resident personal funds for one of three residents (R14) reviewed for resident funds. Findings include: On 3/18/25 at 11:12am R14 said he only receives 30 dollars a month, R14 said he's not sure of his trust fund statement, R14 said he's not sure about his account balance. On 3/20/25 at 10:36pm V22 (Business Office Manager) said R14 has a resident trust fund account. V22 presents documentation denoting R14 has 1510.13 dollars in his resident trust fund account, print date 3/20/25. V22 said the 1510.13 is R14's total balance. During a follow up interview V22 said R14 only has 754.00 dollars in his trust fund account. V22 said she has not been keeping an accurate account of R14's resident trust fund. Facility policy titled RESIDENT PERSONAL TRUST FUNDS dated 4/2024 denotes in-part, purpose: It is the practice of this facility to hold, safeguard, manage and account for personal funds if any resident requests facility to establish personal funds account in their behalf…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-03-21 · tag F0644 — isolated
  Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
  What the surveyor found here — the official record, unedited, may be distressing

  Based on interview and record review the facility failed to refer a resident with mental health diagnosis for PASARR level 2 screening for one of three residents (R61) reviewed for PASARR screening/assessments. Findings include: 3/20/25 V8 (Social Service Director) said R61 was not referred for PASARR level two screening. V8 said it was an error, R61 has SMI diagnosis, it was an oversite. R61 face sheet shows R61 was diagnoses with depression on 11/18/24. R61 MDS section I dated 1/2/25 for diagnosis denotes depression.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2025-01-14 · tag F0580 — failed to tell family and doctor about changes — isolated
  Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow their notification of change guidelines by not immediately reporting one resident's (R1) fall to the physician and resident representative for one of three residents reviewed for notification. Findings include: R1 was admitted to the facility on [DATE] with a diagnosis of rheumatoid arthritis, depressive disorder, bilateral osteoarthritis of knees, restless leg syndrome, and fibromyalgia. R's1 Brief Interview for Mental Status score dated 11/20/24 documents a score of 14/15 which indicates cognitively intact. Facility reportable dated 12/27/24 documents: On 12/25/24 R1 had witnessed fall while staff was providing care. Family and physician notified on 12/27/24. Facility witness statement by V5 (Nurse) dated 12/27/24 documents: I did not notify anyone. On 1/9/25 at 5:07PM, V5(Nurse) said she received report from R1's aide that she rolled out of bed on Christmas day. V5 said she went to the room and saw R1 on the floor next to low bed. V5 said she…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Rights Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-12-19 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to adequately ensure a resident (R2) was free from abuse. This failure applied to two (R1, R2) of two residents reviewed for abuse. Findings include: R1 is a [AGE] year old male who originally admitted to the facility on [DATE] and later discharged on 11/23/2024. R1 has multiple diagnoses including but not limited to the following: schizoaffective disorder, bipolar disorder, psychoactive substance abuse, depression, psychosis, auditory hallucinations, and suicidal ideations. R2 is a [AGE] year old female who originally admitted to the facility on [DATE] and continues to reside in the facility. R2 has multiple diagnoses including but not limited to the following: COPD, Alzheimer's disease, CAD, type II DM, osteoarthritis, depression, bipolar disorder, and anxiety. Per Minimum Data Set (MDS) dated [DATE], shows R2 has a brief interview of mental status (BIMS) of 14 meaning resident is cognitively intact. On 12/18/2025 at 10:47AM, R2 was interviewed…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-09-25 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to follow their policy and procedures for abuse prevention by not implementing approaches that would reduce the chances of abuse and by not identifying a resident's behaviors that can lead to abuse. This failure applies to four of six residents (R1, R2, R4, and R6) reviewed for abuse. Findings include: R1 is a [AGE] year-old male who was admitted to the facility 02/26/2024 with a diagnosis's history of Schizoaffective Disorder, Schizophrenia, Psychotic Disorder with Delusions, Generalized Anxiety Disorder, Major Depressive Disorder, Violent Behavior, and Drug Induced Secondary Parkinsonism. R1's Level II PASRR (Preadmission Screening and Resident Review) dated 02/26/2024 documents: He has a history of physically acting out towards peers. - A good day is Waking up, eating breakfast, getting sun light, running (partaking in sports), being able to have some peace without people bothering you. - He does not like becoming agitated, verbal aggression, and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-09-25 · tag F0609 — failed to report abuse allegations — isolated
  Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to follow their policy and procedures for abuse reporting by not ensuring an incident of resident-to-resident abuse was reported to the administrator or to the state agency. This failure applies to two of six residents (R4 and R6) reviewed for abuse. Findings include: R4 is a [AGE] year-old female with a diagnosis's history of Bipolar Type Schizoaffective Disorder, Schizophrenia, Epilepsy, and Dementia who was admitted to the facility 07/01/2024. R4's progress note dated 09/19/2024 documents a Certified Nursing Assistant attempted to give brief to R4, she then turned around and scratched her arm. She also scratched another resident on her arm as well as she was walking by. On 09/24/2024 at 10:18 AM, V4 (Certified Nursing Assistant) stated R4 has scratched a resident before. V4 stated R4 can become physically aggressive at times based on how she is approached by staff or if residents are saying things to or around her that she doesn't like. R6 is a [AGE]…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-09-25 · tag F0656 — failed to write and follow a full care plan — isolated
  Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to follow their policy and procedures for care planning by not preparing a comprehensive care plan including residents identified preferences, problems, risk factors, and needs. This failure applies to two of six residents (R1 and R4) reviewed for care planning. Findings include: R1 is a [AGE] year-old male who was admitted to the facility 02/26/2024 with a diagnosis's history of Schizoaffective Disorder, Schizophrenia, Psychotic Disorder with Delusions, Generalized Anxiety Disorder, Major Depressive Disorder, Violent Behavior, and Drug Induced Secondary Parkinsonism. R1's Level II PASRR (Preadmission Screening and Resident Review) dated 02/26/2024 documents: He enjoys sports, soccer, food, and eating. -Soccer is his favorite. -He is good at playing sports, school, and running. -A good day is Waking up, eating breakfast, getting sun light, running (partaking in sports), being able to have some peace without people bothering you. -A Career, education, and…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Resident Assessment and Care Planning Deficiencies · Deficient, Provider has date of correction
• Potential for harm · D2024-09-25 · tag F0741 — failed to have staff trained for behavioral health — isolated
  Ensure that the facility has sufficient staff members who possess the competencies and skills to meet the behavioral health needs of residents.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interviews and record reviews the facility failed to follow their policy and procedures for provision of social services by not ensuring there is a sufficient number of social services staff to serve the needs of their residents. This failure applies to one of six residents (R1) reviewed for behavioral health services. Findings include: R1 is a [AGE] year-old male who was admitted to the facility 02/26/2024 with a diagnosis's history of Schizoaffective Disorder, Schizophrenia, Psychotic Disorder with Delusions, Generalized Anxiety Disorder, Major Depressive Disorder, Violent Behavior, and Drug Induced Secondary Parkinsonism. R1's current care plan documents he has violent behavior related to Schizoaffective disorder, Bipolar type and has a history of aggressive behavior, and has little interest or pleasure in doing things. R1's Level II PASRR (Preadmission Screening and Resident Review) dated 02/26/2024 documents: He has a history of physically acting out towards peers. He has Level II PASRR conditions…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Quality of Life and Care Deficiencies · Deficient, Provider has date of correction
• Potential for harm · Dcited before2024-07-19 · tag F0600 — failed to protect residents from abuse and neglect — isolated
  Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.
  What the surveyor found here — an excerpt from the official record, may be distressing

  NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to follow their abuse policy by allowing a staff member to tease and laugh at a resident. This failure affected one of three residents (R2) reviewed for abuse. Findings Include: R2 is a [AGE] year old with the following diagnosis: bipolar disorder, schizophrenia, and drug induced parkinsonism. R3 is a [AGE] year old with the following diagnosis: bipolar disorder, anxiety, and spina bifida. The Final Incident Report dated 7/3/24 documents R2 reported to V1(Adminsitrator) on 6/27/24 that V5, V8, and V9 were verbally inappropriate to R2 on the overnight shift on 6/23 through 6/24/24. R2 reported staff were calling R2 names and talked about R2 ' s mom. R2 also stated staff laughed at R2. Upon interview, the three staff members denied the allegation. They stated R2 was very shaky and was being monitored in the dining room due to being a potential fall risk. R3 witnessed V5 and V8 in the dining room with R2. R3 stated a similar version that V5 and V8 were…

  This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

  Freedom from Abuse, Neglect, and Exploitation Deficiencies · Deficient, Provider has date of correction

“Cited before” means this same F-tag appears on at least one other survey date in the record we hold — counting complaint investigations as well as standard surveys, with no time limit. It is our own read of the data, not CMS’s: CMS uses repeat deficiency as a formal term tied to consecutive standard surveys, and that is a narrower test than this one. A tag marked here may or may not meet it.

Fines & penalties

$350,672 in federal fines across 3 penalties. 1 Medicare payment denial on record.

• $131,763 — penalty dated 2025-01-14
• $79,590 — penalty dated 2024-01-25
• $139,319 — penalty dated 2023-11-02
• Medicare payment denial — starting 2025-02-07 for 1 days

Dates are the dates CMS records the penalty, not the date of the conduct behind it. CMS publishes penalties on a rolling window, so this is what is currently on the public file — not the home’s lifetime history, and an older fine may attach to a problem that has since been corrected. The amounts are as imposed: the CMS file does not record whether a penalty was appealed, reduced, or paid, so we don’t say. Ask the home what each one was for and what changed since.

Part of a chain

This home belongs to WISSATI IRREVOCABLE TRUST — 5 facilities. Here is how its ratings compare with the chain’s average across all its homes: See the whole chain — ratings, flags, fines and finances →

A home rated well below its chain’s average can signal local problems; a chain with a low average across the board is a bigger pattern worth researching. CMS chain data under-reports private-equity and REIT ownership, so treat this as a floor, not the full picture.

Who owns this facility

CMS files one row per role, so the 19 rows in the source record cover these 11 parties — each is shown once here with every role it holds. Nothing is omitted. The source lists no ownership percentage for any of them — PECOS records a share only for equity interests, not for board or management roles.

3 organizational owners listed — a facility can be part of a larger chain. CMS ownership data is known to under-report private-equity and REIT ties; treat as a starting point.

Follow the money — this home’s finances

Where a nursing home’s revenue comes from and where it goes — including money paid to companies under the same ownership. Most consumer sites never show this; we reproduce it straight from the Medicare cost report.

About 93% of this home’s resident-days are paid by Medicaid, which reimburses well below the cost of care in most states. Heavily Medicaid-dependent homes run on thinner budgets — a context worth holding next to the staffing and inspection record, not a fault in itself. This home reported $727K paid to related parties — landlords or management companies under common ownership — equal to about 11% of its total expenses. Money routed to affiliated companies can leave a home’s own books looking lean while owners still profit; it is the mechanism regulators watch most closely in private-equity and REIT deals. A reported operating loss is common in this industry and is not by itself a sign of trouble — but paired with large related-party payments it can mean profit is being taken elsewhere in the ownership structure.

Source: CMS Healthcare Provider Cost Reporting Information System (HCRIS), Medicare cost report Form CMS-2540 · fiscal year 2023. Facilities self-file these reports; figures are unaudited and a year or two behind. A home with no Medicare cost report on file shows no figures here.

Cost & finances

Straight from this home’s Medicare cost report (CMS, FY2023). These are its operating economics — what it costs to run per resident-day and what it collects on average across Medicare, Medicaid, and private pay — not a private-pay quote. Your out-of-pocket cost depends on payer and room type, so ask the facility directly; a higher operating cost can reflect richer staffing or a sicker population. The cost-of-care planner shows regional benchmarks by care type.

What families pay in IL